Always Be Prepared for the Unexpected

BY BRIAN WARD

I once heard an individual say that we do not have to know 100 percent of the job, 100 percent of the time. He went on to mention how he would never run all of the types of calls in one shift. The first and most obvious problem with this philosophy is, how do you know which calls you are going to run that shift? The second problem is, what happens when you do run the seldom-seen incidents in the same shift? Training for incidents that are not the norm is essential to our performing efficiently and professionally.

During one of my shifts as the engine officer with Gwinnett County (GA) Fire and Emergency Services, I encountered two drastically different and unusual incidents. Both required looking at the big picture and thinking before acting. In addition to the type of call, the driver and I were riding with a four-month rookie. This is partially the same crew that was with me one month before when we were first on scene at a hydrogen sulfide hazmat suicide (see “Lessons Learned from a Hydrogen Sulfide Incident,” Fire Engineering, November 2011) and a double-shooting homicide. The amount of experience of each individual riding on the apparatus changed how I approached each situation. These considerations change your decision-making process drastically as you ensure the safety of the crew.

The first question the officer has to answer is, what can I expect my crew to safely accomplish? As I have discussed in prior articles, crew resource management (CRM), which includes situational awareness, communication, and task allocation, becomes very important. In situations similar to this, the use and understanding of CRM will enable crews with less experience (veteran crews as well) to perform more safely and effectively. CRM will help firefighters and officers develop a plan that matches their strengths and weaknesses when mitigating a situation.

INCIDENT 1: INDUSTRIAL ACCIDENT

Our engine and an ambulance from another station were dispatched to an industrial accident involving an employee’s arm being entrapped in a machine. The employee had climbed over a trip wire that should have shut off the machine; this was put in place as a form of guarding to keep employees from getting too close to the rollers. As I read through the mobile data terminal in the engine, I reviewed several considerations including personnel, tools, location, and expertise of the engine crew with this type of incident. Previously, I had spent two years on our technical rescue team (TRT), and I was familiar with its numerous capabilities. On further investigation, the first-in truck picked up the call, along with the acting battalion chief and our TRT squad. En route to the incident, the truck and I discussed notifying the TRT because of its “Man and Machine Kit.” This kit has several pneumatic, nonsparking, and metal-cutting tools we could use if needed.

The first obstacle was the location of the plant. The address of the call was not the address of the incident; the two buildings were within a half mile of each other but not at the same location. This information must be relayed to incoming units. Once inside the plant, we encountered the patient propping himself on the machine while his left arm was pinned between two steel rollers. The machine had picked the patient off the ground and left him suspended in air. Obviously, the first impression of the patient was that he was in extreme pain as the rollers, both attached with brushes, were clamped on his arm. This particular machine was used in a coating process for paint canvases (photo 1). Note the very top of the photo, where the rollers are. This is where the patient’s arm was pinned. Photo 2 shows the rollers from a side view.

(1) Canvas coater.

(2) The patient’s arm was at the arrow between two steel rollers with brushes.

Prior to our arrival, the plant’s maintenance crew was attempting to find a way to disassemble the machine to free the patient’s arm. As the first responding unit, our first priority was to verify that the machine was tagged out and locked out. It may be best to leave a firefighter by the lockout to ensure that no one turns the machine back on. Once the coworkers heard the patient yelling, they rushed over and immediately shut off the machine, locking it out. However, it is important to verify this for yourself.

After some discussion on how to extricate the victim, several options were considered. The first was to use the jaws and spread the rollers apart while cribbing between the rollers to prevent them from collapsing back onto the patient’s arm. Because of the roller’s shape, it was determined that the rollers would spin instead of spread. The second option was to pull the gears and packing off with a three-prong puller (photo 3). The three-prong puller comes in different sizes, and the maintenance crew should have the appropriate sizes available. This took apart the system, and we were able to slide the rollers out and off the patient’s arm within about 15 minutes.

(3) Three-prong puller.

While this was being done, patient care was underway on the opposite side of the machine. Obtaining vital signs and establishing an IV were paramount, as time was critical; this was a “load and go” situation on extrication. Because of the time the patient’s arm was in the machine, it was possible that his arm would have to be amputated. The entire incident took approximately 25 minutes from arrival to transport to the emergency room. The patient received third-degree burns to both sides of his left bicep and had minimum circulation in his left radial. There may have been some underlying issues that we could not see; however, there did not appear to be any crushed or fractured bones. Considering the potential for injury, the patient seemed to be lucky to have only burn injuries, as painful as they are, from the rollers.

In this type of incident, it is best to allow the individuals who know the equipment best and who work with it every day (maintenance crew) to advise on how to disassemble it. The fire department should provide assistance and ensure that firefighters and maintenance personnel are performing safely and that no further injuries occur. Good communication between the crews will ensure that the incident will go as smoothly as possible.

INCIDENT 2: MAN ON FIRE

The second incident was dispatched as a grass fire between an apartment complex and a Wal-Mart. The first thought was that this fire would be extinguished with tank water and our crews would be back in service in 30 minutes. However, according to the degree of fire extension and the number of nearby exposures, there was also the possibility that it could turn into an extremely difficult situation. Among the serious considerations were the distance between the buildings and the fire, building construction features such as vinyl siding on the apartments, and the possibility that embers might fall onto Wal-Mart’s rolled rubber membrane roof. These and many other scenarios were being played out in my head while responding. However, the one scenario I failed to anticipate was about to come next from dispatch.

Dispatch reported that a patient with his clothes on fire was running between Wal-Mart and the apartment complex and was attempting to undress. While en route, the first-in truck company, the medical supervisor, and the acting battalion chief picked up on the call. The first-in unit was an ambulance that was just leaving the hospital; the engine company arrived seconds later. On their arrival, pine straw was burning in a thin patch of woods on one side of the street; pavement was between the fire and both buildings (photo 4). The fire was not very extensive; it covered approximately 3,000 square feet. After noticing the fire blocks (pavement) between these exposures and the level of extension, I saw life safety and exposures hazards would not be issues if delayed until additional apparatus arrived. The first priority was to find and treat the patient reported in the dispatch.

(4) Woods area on fire.

The patient was found lying in the dirt approximately 50 feet from the burning area. He was in obvious distress and was clearly burned over 70 percent of his body. While the ambulance and engine crew were providing patient care, the first option was to fly the patient out. It turned out that this was not feasible because there were wind gusts of 15-20 miles per hour and Life Flight had a delayed response time of 19 minutes. It was determined that it would be just as quick to go by ground. The patient was immediately loaded into the ambulance, and care continued. Because of the burns and the difficulty in locating the patient’s veins, the medical responders went with an intraosseous infusion instead of large-bore IVs.

During this time, command had been turned over to the truck company captain and eventually to the acting battalion chief as the truck company firefighter began fire suppression. Several circumstances, including the injury of a civilian, involved in this incident made it an active crime scene, and our arson investigators and the local police were called to the scene. On further inspection, a gas can and several unidentified articles were discovered within the burn area. The truck company tried to minimize any disturbance to the gas can and other evidence while extinguishing the surrounding fire. We activated the public information officer (PIO) because the incident had great publicity potential and media helicopters began to circle the incident. Since this was an active crime scene, all comments had to come from one designated individual, the PIO. Firefighters should be careful in these types of situations not to provide any information to the news media or the general public.

LESSONS LEARNED

Throughout both incidents, the safety of the crews was of the utmost importance, whether it was verifying that a machine had been locked out or assessing the hazards of fire exposures.

Sometimes the incident to which you are dispatched is not the one you find when you arrive, such as the grass fire, where there was a civilian on fire. The challenges we faced at the industrial accident are not situations we encounter every day. In these unfamiliar situations, we must remember to stay calm and think about what resources we have. I was fortunate to have been assigned to the TRT previously and knew what its capabilities were. If you are not sure, ask. I was also thankful to have the rookie on board: He was only a rookie in the fire service, but he was also a licensed master electrician, a vital resource when considering the electrical and mechanical injury potential.

CRM is vital for dealing with unfamiliar incidents. Good communication will ensure that items such as locking out the machinery and ensuring that personnel are wearing proper personal protective equipment for the incident have been verified. Also, communication between the industrial maintenance crew and the fire department is vital for a successful operation. Situational awareness is equally important. Remember, situational awareness is the ability to recognize the situation, understand its characteristics and components, and foresee how the incident will develop.

Task allocation played a large role in both of these incidents. The experience level of the individuals on the engine dictated my actions and decisions concerning the tasks I would ask them to accomplish.

As emergency responders, we are servants of the public and cannot dictate, decide, or influence the calls we will run. We must be able to stay calm and work through difficult or unfamiliar situations. Developing this ability requires constant and effective training in a variety of situations. As Atlanta (GA) Fire Department Battalion Chief David Rhodes says: “We have to train for adaptability—the ability to encounter any situation and rely on previous training to deliver a positive outcome no matter what situation we face.”

BRIAN WARD is the chief of emergency operations and training director for Georgia Pacific—Madison, Georgia. He is a past training officer for Gwinnett County, Georgia; chairman of the Metro Atlanta Training Officers; and a member of the Honeywell Advisory Council. He is a Georgia advocate for Everyone Goes Home and the International Society of Fire Service Instructors’ Membership Task Force co-chair and lead live fire instructor. He was recently awarded the National Seal of Excellence from the National Fallen Firefighters Foundation/Everyone Goes Home. He has a bachelor’s degree in fire safety and technology engineering from the University of Cincinnati. He is the founder of FireServiceSLT.com and Georgia Smoke Diver #741.